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出境医 / 临床实验 / TACE Combined With Methylcantharidimide Tablets in the Treatment of Large and Unresectable Hepatocellular Carcinoma

TACE Combined With Methylcantharidimide Tablets in the Treatment of Large and Unresectable Hepatocellular Carcinoma

Study Description
Brief Summary:
The purpose of this study is to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with methylcantharidimide tablets in the treatment of patients with large and unresectable hepatocellular carcinoma.

Condition or disease Intervention/treatment Phase
Hepatocellular Carcinoma Drug: methylcantharidimide tablets Phase 4

Detailed Description:

Most guidelines recommend transarterial chemoembolization (TACE), as the standard of care for unresectable hepatocellular carcinoma (HCC ) at Barcelona Clinic Liver Cancer (BCLC) stage A-B. While a number of studies demonstrate poor effect of TACE for patients with large hepatocellular carcinoma. The efficacy of TACE on large (≥ 10 cm) stage A-B HCC is far from satisfactory. The median overall survival was only 6.5-9.1 months. Methylcantharidimide is a single molecule drug used for the treatment of primary liver cancer.

Thus, the investigators carried out this prospective trial to demonstrate the efficacy and safety of TACE combined with methylcantharidimide tablets in patients with large and unresectable hepatocellular carcinoma.

Study Design
Layout table for study information
Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 22 participants
Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description: TACE plus methylcantharidimide tablets
Masking: None (Open Label)
Primary Purpose: Treatment
Official Title: A Prospective Clinical Trial of TACE Combined With Methylcantharidimide Tablets in the Treatment of Large and Unresectable Hepatocellular Carcinoma
Estimated Study Start Date : July 20, 2019
Estimated Primary Completion Date : July 20, 2020
Estimated Study Completion Date : February 1, 2021
Arms and Interventions
Arm Intervention/treatment
Experimental: TACE plus methylcantharidimide tablets
Methylcantharidimide tablets( 75mg po tid) is administered before first TACE 3 days and taken continuously after TACE treatment. Every 6 weeks is a cycle.
Drug: methylcantharidimide tablets

Drug: methylcantharidimide tablets

Methylcantharidimide is a single molecule drug used for the treatment of primary liver cancer.

Procedure: TACE

Transcatheter arterial chemoembolization was performed by the injection of small embolic particles coated with chemotherapeutic agents selectively into an artery directly supplying a tumor.

Other Name: GANYU

Outcome Measures
Primary Outcome Measures :
  1. Disease control rate (DCR) [ Time Frame: 18 months ]
    DCR was defined as the percentage of participants with a best overall response of complete response (CR) or partial response (PR), or stable disease (SD). CR was defined as disappearance of any intratumoral arterial enhancement in all target lesions. PR was defined as at least a 30% decrease in the sum of diameters of viable (enhancement of arterial phase) target lesions taking as reference the baseline sum of the diameters of target lesions. SD was when a case does not qualify for either PR or progressive disease (PD) and was new non-target lesions. PD was defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the baseline sum of diameters of target lesions.


Secondary Outcome Measures :
  1. Time to progression (TTP) [ Time Frame: 18 months ]
    TTP was defined as the time from the date of treatment to the date of first documentation of disease progression based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Disease progression was defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the baseline sum of diameters of target lesions.

  2. Overall Survival (OS) [ Time Frame: 18 months ]
    From the date of treatment until the date of death from any cause

  3. Health Related Quality of Life (HRQoL) [ Time Frame: 18 months ]
    HRQoL assessed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) .The EORTC QLQ-C30 included 30 questions comprising 9 multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social) and 9 symptom scales (fatigue, pain, nausea/vomiting, dyspnoea, appetite loss, insomnia, constipation, diarrhea and financial difficulties) and a single global health and quality of life status score. Most questions used a 4-point scale (1=Not at all to 4=Very much); 2 questions used a 7-point scale (1= Very poor to 7=Excellent). All domain scores were calculated as an average of item scores and transformed to 0 to 100 score range. A high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/quality of life (QoL) represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problem.

  4. clinical symptoms [ Time Frame: 18 months ]
    A questionnaire about the clinical symptoms, appetite,pain and sleep.

  5. Adverse Events [ Time Frame: 18 months ]
    Postoperative adverse events were graded based on CTCAE v4.03


Eligibility Criteria
Layout table for eligibility information
Ages Eligible for Study:   18 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  1. Age range from 18-75 years;
  2. KPS≥70;
  3. The diagnosis of HCC was based on the diagnostic criteria for HCC used by the European Association for the Study of the Liver (EASL);
  4. Simultaneously staged as BCLC A or BCLC B based on Barcelona Clinic Liver Cancer staging system;
  5. Patients must have at least one tumor lesion that can be accurately measured;
  6. Solitary tumor with diameter ≥10cm, or multiple tumors, diameter of the largest was more than 7cm;
  7. Diagnosed as unresectable with consensus by the panel of liver surgery experts,
  8. Re commanded treated by TACE with consensus by the panel of liver multi-disciplinary treatment (MDT);
  9. No past history of TACE, chemotherapy or molecule-targeted treatment;
  10. No Cirrhosis or cirrhotic status of Child-Pugh class A only;
  11. No liver protection therapy in 2 weeks before enrolled, and meet the following laboratory parameters:(a) Platelet count ≥ 75,000/μL; (b)Hemoglobin ≥ 8.5 g/dL;(c) Total bilirubin ≤ 30mmol/L;(d) Serum albumin ≥ 32 g/L;(e) Glutamic pyruvic transaminase (ALT) and glutamic oxalacetic transaminase (AST) ≤ 6 x upper limit of normal;(f) Serum creatinine≤ 1.5 x upper limit of normal;(g) international normalized ratio(INR)> 2.3 or prothrombin time (PT)/activated partial thromboplastin time (APTT) within normal limits; (h) Absolute neutrophil count (ANC) >1,500/mm3;
  12. Ability to understand the protocol and to agree to sign a written informed consent document.

Exclusion Criteria:

  1. Factors that affect oral administration, such as dysphagia, chronic diarrhea and intestinal obstruction;
  2. Patients with clinically significant gastrointestinal bleeding within 30 days prior to study entry;
  3. Known of serious heart disease which can nor endure the treatment such as cardiac ventricular arrhythmias requiring anti-arrhythmic therapy;
  4. Evidence of hepatic decompensation including ascites, gastrointestinal bleeding or hepatic encephalopathy;
  5. Known history of HIV;
  6. History of organ allograft;
  7. Known or suspected allergy to the investigational agents or any agent given in association with this trial;
  8. Evidence of bleeding diathesis;
  9. Any other hemorrhage/bleeding event > CTCAE Grade 3 within 4 weeks of first dose of study drug;
  10. Serious non-healing wound, ulcer, or bone fracture;
  11. Known central nervous system tumors including metastatic brain disease;
  12. Poor compliance that can not comply with the course of treatment and follow up;
  13. Factors that the researchers consider it not appropriate to be included
Contacts and Locations

Contacts
Layout table for location contacts
Contact: Lei Chen, MD +86-13771775313 leichensz@sina.com
Contact: Mo Zhou +86 0512-62362596 szslyyec@163.com

Locations
Layout table for location information
China, Jiangsu
Suzhou Municipal Hospital
Suzhou, Jiangsu, China, 215008
Contact: Mo Zhou, MD    +86 0512-62362596    szslyyec@163.com   
Sponsors and Collaborators
Suzhou Municipal Hospital
Investigators
Layout table for investigator information
Principal Investigator: Lei Chen, MD Suzhou Municipal Hospital
Tracking Information
First Submitted Date  ICMJE June 21, 2019
First Posted Date  ICMJE June 25, 2019
Last Update Posted Date June 25, 2019
Estimated Study Start Date  ICMJE July 20, 2019
Estimated Primary Completion Date July 20, 2020   (Final data collection date for primary outcome measure)
Current Primary Outcome Measures  ICMJE
 (submitted: June 21, 2019)
Disease control rate (DCR) [ Time Frame: 18 months ]
DCR was defined as the percentage of participants with a best overall response of complete response (CR) or partial response (PR), or stable disease (SD). CR was defined as disappearance of any intratumoral arterial enhancement in all target lesions. PR was defined as at least a 30% decrease in the sum of diameters of viable (enhancement of arterial phase) target lesions taking as reference the baseline sum of the diameters of target lesions. SD was when a case does not qualify for either PR or progressive disease (PD) and was new non-target lesions. PD was defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the baseline sum of diameters of target lesions.
Original Primary Outcome Measures  ICMJE Same as current
Change History No Changes Posted
Current Secondary Outcome Measures  ICMJE
 (submitted: June 21, 2019)
  • Time to progression (TTP) [ Time Frame: 18 months ]
    TTP was defined as the time from the date of treatment to the date of first documentation of disease progression based on modified Response Evaluation Criteria in Solid Tumors (mRECIST). Disease progression was defined as at least a 20% increase in the sum of diameters of target lesions, taking as reference the baseline sum of diameters of target lesions.
  • Overall Survival (OS) [ Time Frame: 18 months ]
    From the date of treatment until the date of death from any cause
  • Health Related Quality of Life (HRQoL) [ Time Frame: 18 months ]
    HRQoL assessed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) .The EORTC QLQ-C30 included 30 questions comprising 9 multi-item scales: 5 functional scales (physical, role, cognitive, emotional, and social) and 9 symptom scales (fatigue, pain, nausea/vomiting, dyspnoea, appetite loss, insomnia, constipation, diarrhea and financial difficulties) and a single global health and quality of life status score. Most questions used a 4-point scale (1=Not at all to 4=Very much); 2 questions used a 7-point scale (1= Very poor to 7=Excellent). All domain scores were calculated as an average of item scores and transformed to 0 to 100 score range. A high score for a functional scale represents a high/healthy level of functioning, a high score for the global health status/quality of life (QoL) represents a high QoL, but a high score for a symptom scale/item represents a high level of symptomatology/problem.
  • clinical symptoms [ Time Frame: 18 months ]
    A questionnaire about the clinical symptoms, appetite,pain and sleep.
  • Adverse Events [ Time Frame: 18 months ]
    Postoperative adverse events were graded based on CTCAE v4.03
Original Secondary Outcome Measures  ICMJE Same as current
Current Other Pre-specified Outcome Measures Not Provided
Original Other Pre-specified Outcome Measures Not Provided
 
Descriptive Information
Brief Title  ICMJE TACE Combined With Methylcantharidimide Tablets in the Treatment of Large and Unresectable Hepatocellular Carcinoma
Official Title  ICMJE A Prospective Clinical Trial of TACE Combined With Methylcantharidimide Tablets in the Treatment of Large and Unresectable Hepatocellular Carcinoma
Brief Summary The purpose of this study is to evaluate the efficacy and safety of transarterial chemoembolization (TACE) combined with methylcantharidimide tablets in the treatment of patients with large and unresectable hepatocellular carcinoma.
Detailed Description

Most guidelines recommend transarterial chemoembolization (TACE), as the standard of care for unresectable hepatocellular carcinoma (HCC ) at Barcelona Clinic Liver Cancer (BCLC) stage A-B. While a number of studies demonstrate poor effect of TACE for patients with large hepatocellular carcinoma. The efficacy of TACE on large (≥ 10 cm) stage A-B HCC is far from satisfactory. The median overall survival was only 6.5-9.1 months. Methylcantharidimide is a single molecule drug used for the treatment of primary liver cancer.

Thus, the investigators carried out this prospective trial to demonstrate the efficacy and safety of TACE combined with methylcantharidimide tablets in patients with large and unresectable hepatocellular carcinoma.

Study Type  ICMJE Interventional
Study Phase  ICMJE Phase 4
Study Design  ICMJE Allocation: N/A
Intervention Model: Single Group Assignment
Intervention Model Description:
TACE plus methylcantharidimide tablets
Masking: None (Open Label)
Primary Purpose: Treatment
Condition  ICMJE Hepatocellular Carcinoma
Intervention  ICMJE Drug: methylcantharidimide tablets

Drug: methylcantharidimide tablets

Methylcantharidimide is a single molecule drug used for the treatment of primary liver cancer.

Procedure: TACE

Transcatheter arterial chemoembolization was performed by the injection of small embolic particles coated with chemotherapeutic agents selectively into an artery directly supplying a tumor.

Other Name: GANYU
Study Arms  ICMJE Experimental: TACE plus methylcantharidimide tablets
Methylcantharidimide tablets( 75mg po tid) is administered before first TACE 3 days and taken continuously after TACE treatment. Every 6 weeks is a cycle.
Intervention: Drug: methylcantharidimide tablets
Publications *
  • He MK, Le Y, Li QJ, Yu ZS, Li SH, Wei W, Guo RP, Shi M. Hepatic artery infusion chemotherapy using mFOLFOX versus transarterial chemoembolization for massive unresectable hepatocellular carcinoma: a prospective non-randomized study. Chin J Cancer. 2017 Oct 23;36(1):83. doi: 10.1186/s40880-017-0251-2.
  • Xue T, Le F, Chen R, Xie X, Zhang L, Ge N, Chen Y, Wang Y, Zhang B, Ye S, Ren Z. Transarterial chemoembolization for huge hepatocellular carcinoma with diameter over ten centimeters: a large cohort study. Med Oncol. 2015 Mar;32(3):64. doi: 10.1007/s12032-015-0504-3. Epub 2015 Feb 15.
  • Huang YH, Wu JC, Chen SC, Chen CH, Chiang JH, Huo TI, Lee PC, Chang FY, Lee SD. Survival benefit of transcatheter arterial chemoembolization in patients with hepatocellular carcinoma larger than 10 cm in diameter. Aliment Pharmacol Ther. 2006 Jan 1;23(1):129-35.
  • Poon RT, Ngan H, Lo CM, Liu CL, Fan ST, Wong J. Transarterial chemoembolization for inoperable hepatocellular carcinoma and postresection intrahepatic recurrence. J Surg Oncol. 2000 Feb;73(2):109-14.

*   Includes publications given by the data provider as well as publications identified by ClinicalTrials.gov Identifier (NCT Number) in Medline.
 
Recruitment Information
Recruitment Status  ICMJE Unknown status
Estimated Enrollment  ICMJE
 (submitted: June 21, 2019)
22
Original Estimated Enrollment  ICMJE Same as current
Estimated Study Completion Date  ICMJE February 1, 2021
Estimated Primary Completion Date July 20, 2020   (Final data collection date for primary outcome measure)
Eligibility Criteria  ICMJE

Inclusion Criteria:

  1. Age range from 18-75 years;
  2. KPS≥70;
  3. The diagnosis of HCC was based on the diagnostic criteria for HCC used by the European Association for the Study of the Liver (EASL);
  4. Simultaneously staged as BCLC A or BCLC B based on Barcelona Clinic Liver Cancer staging system;
  5. Patients must have at least one tumor lesion that can be accurately measured;
  6. Solitary tumor with diameter ≥10cm, or multiple tumors, diameter of the largest was more than 7cm;
  7. Diagnosed as unresectable with consensus by the panel of liver surgery experts,
  8. Re commanded treated by TACE with consensus by the panel of liver multi-disciplinary treatment (MDT);
  9. No past history of TACE, chemotherapy or molecule-targeted treatment;
  10. No Cirrhosis or cirrhotic status of Child-Pugh class A only;
  11. No liver protection therapy in 2 weeks before enrolled, and meet the following laboratory parameters:(a) Platelet count ≥ 75,000/μL; (b)Hemoglobin ≥ 8.5 g/dL;(c) Total bilirubin ≤ 30mmol/L;(d) Serum albumin ≥ 32 g/L;(e) Glutamic pyruvic transaminase (ALT) and glutamic oxalacetic transaminase (AST) ≤ 6 x upper limit of normal;(f) Serum creatinine≤ 1.5 x upper limit of normal;(g) international normalized ratio(INR)> 2.3 or prothrombin time (PT)/activated partial thromboplastin time (APTT) within normal limits; (h) Absolute neutrophil count (ANC) >1,500/mm3;
  12. Ability to understand the protocol and to agree to sign a written informed consent document.

Exclusion Criteria:

  1. Factors that affect oral administration, such as dysphagia, chronic diarrhea and intestinal obstruction;
  2. Patients with clinically significant gastrointestinal bleeding within 30 days prior to study entry;
  3. Known of serious heart disease which can nor endure the treatment such as cardiac ventricular arrhythmias requiring anti-arrhythmic therapy;
  4. Evidence of hepatic decompensation including ascites, gastrointestinal bleeding or hepatic encephalopathy;
  5. Known history of HIV;
  6. History of organ allograft;
  7. Known or suspected allergy to the investigational agents or any agent given in association with this trial;
  8. Evidence of bleeding diathesis;
  9. Any other hemorrhage/bleeding event > CTCAE Grade 3 within 4 weeks of first dose of study drug;
  10. Serious non-healing wound, ulcer, or bone fracture;
  11. Known central nervous system tumors including metastatic brain disease;
  12. Poor compliance that can not comply with the course of treatment and follow up;
  13. Factors that the researchers consider it not appropriate to be included
Sex/Gender  ICMJE
Sexes Eligible for Study: All
Ages  ICMJE 18 Years to 75 Years   (Adult, Older Adult)
Accepts Healthy Volunteers  ICMJE No
Contacts  ICMJE Contact information is only displayed when the study is recruiting subjects
Listed Location Countries  ICMJE China
Removed Location Countries  
 
Administrative Information
NCT Number  ICMJE NCT03996681
Other Study ID Numbers  ICMJE 20190124R0
Has Data Monitoring Committee Yes
U.S. FDA-regulated Product
Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
IPD Sharing Statement  ICMJE
Plan to Share IPD: Yes
Plan Description: all individual participant data (IPD) that underlie results in a publication
Time Frame: starting 6 months after publication
Access Criteria: Case Report Form (CRF)
Responsible Party Lei Chen, Suzhou Municipal Hospital
Study Sponsor  ICMJE Suzhou Municipal Hospital
Collaborators  ICMJE Not Provided
Investigators  ICMJE
Principal Investigator: Lei Chen, MD Suzhou Municipal Hospital
PRS Account Suzhou Municipal Hospital
Verification Date June 2019

ICMJE     Data element required by the International Committee of Medical Journal Editors and the World Health Organization ICTRP